16685 SW QUEEN MARY AVENUE 16685 SW ')ueer Mary Avenue
\ CITY O F T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00415
'3125 SV'I Hall Blvd , Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/28/02
SITE ADDRESS: 16685 SW QUEEN MARY AVE PARCEL: 2S115BC-02600
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: OTR GARBA iE DISPOSALS: MOBILE HOME SPACES:
-TYPE OF USE: SF WASHING, MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES_ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN ft
Remarks: Install 100'water service.
----- --- FEES ------------------
Owner: =_ ------ - — ----__-_-
--- Descriptio,i Date Amount
BROOKS, CLYDE/HELEN I
16685 SW QUEEN MARY AVE I I'L.L!Mhl Pernik Fee 10/28/02 $72.50
KING CITY, OR 97224 IPLUMIii 11cr111it Fec 10/28/02 $0.00
ITAX 18",,State'lax 10/28/02 $5.80
ITA X 18",,State'I ax 10/28/02 $0.00
Phone 1:
Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Water Line Insp
Final Inspection
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes arid all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is susperded
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: - �r cc c� / tom` Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed th , t ext business day
10/23/2002 10:03 5035393771 CITY OF KING CITY PAGE 02/02
Building Fi*tures
Plumbing Petnit Application
Date 7m777
o.
City of 'Tigard II sewepermit no•:Address: 13125 MY Hall Blvd,Tigard,OR 97223Cyrd �� Pro}rot/eppL no.: ate:
Phone: (503) 639-4171--'�
AN, Fax 1503) 598.1960 Date sesued: By: Receipt no.:
Land use approval. case file no.: Payment type:
U 1 &2 falbily dwelling or accessory I❑Commercial/industrial U Muiti-family U Tenant irnprovetnent
U
New construction r]A(ldition/alteration/replacement `]Fon i service, U Other.
1
r • l � Dcscriptinn Q Fee(04.) Total
Job address: t/v /� y�
� Net.1-and Z-frtmily dwrllin);.on t:
g
—Jc__ =L=.U1 a no.; ---- fincladec 100 ft.for rech ulilhp conovMlan)
Tax rlla /tax lot'account no.; SFR 11)bath �e _
Lot: Block: Subdivisi n. — _ SFR 2 bath w
Prefect name: _ SFR 3 bath
Cit (count ZIP_� Eac additiona bath/kitchen
k ju riptt It and locapon of rk on premia s; r- SitentUiNes:
Catch basin/area drain
wet
}r .dote of completion/in pection: rys/sae fine/trenc drain
Fortin drain no.lin.ft.)
Manufactured home utilities
Business name; - _ an o es
Address: Rain drain connector _
Ci St ZIP; _ Sanitary sewer(noon
Phone: Fax: E-mail;
Storm sower�no�,.In.
CCB no.: Plumb.bu ,reg. no —_ Water service no.'.in. ft.
_Ciry/metro filo.no,.- Future or item:
— Abs o tion valve
Contractor's representative signature_ Flack ow reventer _
Print name; Date; Backwater valve
1ON= asins avatory
�lotlles w— ams cr
Nome
—T Dishwasher _
Drin in fountain s
Cit _ Stat Z1P; 8 ( )
._. __�.. errors/sump
phone: Fax; E-mail: Pinanslor.tan
fixture/sewer cap
Floor drain tloor sinks/hub
Name(print): _ -- Gar a e osal
\l Mailing address, ose bibb
1 Cit ► t ZIP. ce tna er
_ Fax mail: Interceptor%grease trap
Owner installation/residential maintenance Iy: The actual installation rimer(s)
will be made by me or the maintenance and pair made by my regular oo ain commerc a
employee on thtt propqq it own as per_AS Chapt r 447. Sink(a),basin(s),lavas)
ownees signature: RES/Shower/shower
m
Tu s/s ower/shower pan
Urinal _
Name: --- Water closet _
Address: _ Water teatef
-------�-1-- ZIP.----- - Yo ef:
Phone: Fax E-mail: -Total
Minimum fee................S
Not all Jattcdiodoos eeew credit cords,ptew tall Jadedialoe r mare Ieform t1of. Notice: Thiappermit application
Plan review(at
O visa U Mastercard expires if a permit is not obtained State surcharge(g9S,)...S
taadlt cad m,meet --A6, --- within 180 days atter it has been ♦t
troe TOTAL.......•.•............ S
�—
sme e u bM n e,�fiow"ran t, it Can
acc�ptt!d as nomplete.
CudhaWervl naMre r s atMd 4404616(Y00/COM)
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST - -- - -
INSPEC'TION DIVISION Business Line: (503)639-4171 BLIP
Received Date Requested '"621 AM.__—_-.- PM _ BLIP
G'�5 5 V1i t'+ )C Suite
MSC
Location IL - - q � -
Contact Person
Ph( �) .L1� CJ�C.--
Contractor Ph SWR
BUILDING _ _
Tenant/Owner ELC
Footing IE LC
Foundation Ar ;ess:
Ftg Drain ELF!
Crawl Drain SIT
Slab I,ispection Notes:
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation _�� j rr - _'�
Drywall Nailing - � ��
LU I
Firewall L /Ll J -['7' /1)/L) �� �� � ��G z ��
Fire Sprinkler >-
Fire Alarm �')�, P6-11
Susp'd Ceiling
Roof -----
Other: �-
Final
PASS PART FAIL
PLUMBING - - -
Post&Beam
Under Slab
Rough-In /
Water Service -- --
Sanitary Sewerzy 7
_
Rain Drains
Catch Basin/Manhole
Storm Drain -
Shower Pan
ti
---- ----- - -__
PART FAIL _
_ANICAL _— -- -- -�
Post& Beam
Rough-In -- --
Gas Line
Smoke Dampers - — -
Final
PASS PART FAIL
ELECTRICAL ----
Service
Rough-In _
UG/Slab
Low Voltage --
Fire Alarm
Final Fj Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
81TE Please call for reinspection RE: F
] Unable to inspect-no access
Fire Supply LineADA �r
Approach/Sidewalk Dab Inspector EXt_--__-
PP
Other:
Final Q N T REMtDVE thisInspectionrecord from the job site.
PASS PART FAIL